What is the symphysis?

The symphysis is located in the pelvis

The symphysis is one of the three joints that hold the pelvic bones together. The symphysis is located in the middle of the front of the pelvis, just below your pubic hair. At the back of the pelvis above your buttocks are the two sacroiliac joints , also known as the SI joints.

The symphysis is therefore the joint located where the pelvic bones—the pubic bones—meet at the front.

The symphysis and sacroiliac joints are all made of cartilage. During pregnancy, they are affected by the hormone relaxin. A brilliant hormone that softens these joints, so the pelvic bones can give way slightly and thus create space for the baby to descend through the pelvis during birth.

Impact on the symphysis

The symphysis plays an important role in absorbing shock, among other things, while walking. During pregnancy, there is also increased pressure on the symphysis as the belly grows. In the final part of pregnancy, some babies lie in such a way for a short or long time that their head “rides on the symphysis,” which feels completely uncomfortable and is completely harmless. In addition, increased fluid in the body can also affect the cartilage tissue of the symphysis, and the changed posture during pregnancy can cause increased strain on the symphysis.

Furthermore, a long range of muscles, fasciae, and ligaments attach in the area around the symphysis. All are working extra hard during pregnancy, which also puts extra strain on the symphysis.

The symphysis is therefore subjected to a little bit of everything throughout pregnancy, which can cause pain.

Many pregnant women experience tenderness at the symphysis, for example when it is pressed during midwife visits, or when the belly’s symphysis-fundal height (the measurement from the top of the symphysis to the top of the uterus) is measured. This is completely normal.

How to take care of your symphysis?

As a pregnant woman, it is a good rule of thumb to imagine that you are wearing a tight skirt that keeps your legs hip-width apart at all times. That is, do not cross your legs (yes, I know it is a very difficult habit to change, but sitting without crossed legs is total symphysis care) and do not sit in extreme positions such as with your legs crossed in a tailor-style position. And yes, I know that some people enjoy this position—even during pregnancy—but for most people, sitting cross-legged will cause symphysis pain over time. 

It is also good to keep moving. When we sit or stand still for a long time, for example at work, our joints become stiff. If you have a sedentary job, I therefore strongly recommend that you sit on a Pilates ball in the right size for you. You can Google a size guide. Make sure the ball is well inflated. When you sit on a Pilates ball, you automatically have a straight back and flat feet on the floor hip-width apart. And without thinking about it, you move a little from side to side or bounce a little. It is simply almost impossible not to 😉 Whether you are sitting on a ball or not, it is good to get up and walk every hour. It can be back and forth to the bathroom, out to make a cup of tea, or something similar. In addition, it is always good and important to listen to your body. Is an evening walk too much for your symphysis? Then take the bike instead. Does chest swimming cause symphysis pain? Then swim crawl (freestyle) instead. Movement is good, as long as you listen to your body. Perhaps you need to modify, scale down, or change your forms of exercise?

And dear you, you must also remember to rest. Lie down a couple of times during the day. Preferably with a good pillow between your thighs/knees. That is pure symphysis care!

What does symphysis pain feel like?

Symphysis pain is often experienced as pain directly in the symphysis area. It can feel like throbbing, stinging, aching, shooting, burning, and swelling, among other things.

The pain can occur suddenly in connection with a movement, for example crossing your legs, or it can occur with a delay, for example after a long walk. I don’t have the exact number of lovely women who have hobbled into the clinic with symphysis pain after yesterday’s slightly (very) too long shopping trip 🙂

In addition, there can be more or less constant pain in the symphysis that feels more like aching or tender swelling.

Symphysis loosening

The word symphysis loosening, refers to symphysis pain. Previously, it was called loosening. However, this gives completely wrong associations, as nothing in the symphysis is loose and nothing can fall apart. Many people also end up confusing symphysis loosening with pelvic loosening. Pelvic loosening must be diagnosed by a doctor and involves all three joints in the pelvic bones, both the symphysis AND the 2 sacroiliac joints at the back.

Symphysis loosening is therefore symphysis pain. In some pregnant women, the pain can affect their quality of sleep and life to such an extent that it also affects both work and leisure.

What can you do about symphysis pain?

In addition to the above advice on how to take care of your symphysis, there are a number of things you can do to relieve your symphysis pain.

• There is a special acupuncture technique called periosteal acupuncture. It takes a few minutes, hurts while you are doing it, and gives many pregnant women relief for hours or even days afterward. The treatment should be repeated 3-4 times over a couple of weeks and can be nicely combined with more general relaxing and soothing acupuncture, which can be a relief if you are walking around tense because of symphysis pain
• Rebozo can relieve symphysis pain for some. Book an appointment with a private midwife who will guide you and your partner through rebozo exercises that suit your exact symptom profile. Something magical about rebozo is that as a pregnant woman, you don’t have to do anything other than receive. And you as a partner have the opportunity to melt and relieve the pain in your pregnant woman’s body
• Place a piece of smooth fabric under your sheet at hip height. It makes it significantly easier for you to turn over at night. The same applies if you sit on a smooth scarf, a smooth bag, or something similar in the car, so it is easier to get in and out—preferably with your legs as close together as possible to take care of your symphysis
• Some pregnant women experience significant pain relief by wearing a pelvic belt. Try it out to see if it helps you, and remember that it doesn’t mean you should rush blindly into everyday life just because you are now pain-relieved. Still think about taking good care of your symphysis and listening to your body’s limits and messages
• Strengthen your pelvic floor. And relax your pelvic floor. It may sound contradictory. But they actually go hand in hand. Because it is good to have strong muscles. And at the same time, it is important to be able to relax the muscles so they are not constantly tense.

The muscles in the pelvic floor help hold the pelvis in place and therefore have an impact on the symphysis

• Seek help. There are more and more physiotherapists with passion and great knowledge about the pregnant pelvis. Visit them for one-on-one treatment and/or guidance on exercises you can do at home
• Put on some music and sway your hips. I know it is not a completely pain-relieving method. But movement increases blood flow and can, for example, help your baby down into the pelvis, so there is less pressure on the symphysis. And dancing brings smiles and joy and boosts your oxytocin , which is the love and well-being hormone. There is also a great opportunity to invite your partner onto the living room or kitchen dance floor. So it is a real win-win 🙂

Warmly

Siff Stephenson, the Heart Midwife